中国实用外科杂志

中国实用外科杂志

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食管胃结合部腺癌471例Siewert分型临床研究

杨    宏a，武爱文a，季加孚a，唐    磊b，吴    齐c   

  1.  北京大学肿瘤医院暨北京市肿瘤防治研究所  恶性肿瘤发病机制及转化研究教育部重点实验室 a.胃肠肿瘤外科；b.影像科；c.内镜室，北京100142
  • 发布日期:2012-03-31

  • Published:2012-03-31

摘要：

目的    探讨食管胃结合部腺癌（AEG）不同Siewert亚型间临床病理特征、手术治疗方式及预后方面的差异。 方法    回顾性分析北京肿瘤医院2002年1月至2008年12月接受外科手术切除的471例AEG病人的临床资料，比较不同Siewert亚型的临床病理特征、手术治疗方式及预后。 结果    全组471例病人中，SiewertⅠ型22例（4.7%），Siewert Ⅱ型237例（50.3%），Siewert Ⅲ型212例（45.0%）。病人的年龄、性别比和体重指数在各组间差异无统计学意义。Ⅲ型较Ⅱ型更容易出现胃壁深层浸润和胃周淋巴结转移，故Ⅲ型比Ⅱ型具有更晚的TNM分期。组织分化程度为G3/4的病人在Ⅲ型中所占的比例明显高于Ⅱ型，脉管癌栓阳性率在Ⅲ型中同样明显高于Ⅱ型。不同的Siewert亚型通常选择不同的手术路径和切除方式。Siewert各亚型病人的5年存活率差异无统计学意义（P=0.308）。对于行R0切除的Ⅱ型和Ⅲ型病人，经腹手术病人的5年存活率优于经胸手术（49.1% vs. 23.3%，P=0.045），而行近端胃大部切除和全胃切除的病人相比，5年存活率差异无统计学意义（40.1% vs. 42.5%，P=0.278）。 结论    Ⅱ型和Ⅲ型AEG具有不同的临床病理学特征，但两组病人的5年存活率差异无统计学意义，可能与随访时间较短有关。对于Ⅱ型和Ⅲ型AEG，建议经腹实施手术，并根据肿瘤的浸润范围选择合适的切除范围。

关键词: 食管胃结合部腺癌, Siewert分型, 临床病理, 手术方式, 预后

Abstract:

Adenocarcinoma of the esophagogastric junction according to Siewert classification: a clinical study of 471 cases        YANG Hong*，WU Ai-wen，JI Jia-fu，et al. *Department of Surgery，Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)，Peking University Cancer Hospital & Institute,Beijing 100142，China
Corresponding author: JI Jia-fu，E-mail:jiafuj@hotmail.com
Abstract    Objective    To clarify the different clinicalpathological characteristics, surgical procedures and prognosis of adenocarcinoma of the esophagogastric junction (AEG) according to Siewert classification. Methods    The clinical data of 471 cases of AEG  underwent resection from January 2002 to December 2008 in Beijing Cancer Hospital were analyzed retrospectively. Clinical pathological characteristics, surgical procedures and prognosis were compared between diffenent Siewert types. Results    Among 471 cases, 22 (4.7%) cases were classified as type I, 237 (50.3%) as type Ⅱ and 212 (45.0%) as type Ⅲ. The age, male to female ratio and BMI had no difference between the different types. The depth of tumor invasion was deeper and the nodal metastases were more frequent in type Ⅲ compared with type Ⅱ, which also meant type Ⅲ tumors demonstrated a more advanced stage than type Ⅱ. Moreover, the pathological grade was higher and the lymphovascular invasion was more frequent in type Ⅲ than type Ⅱ. Surgical approaches and procedures differed among different Siewert types. The 5-year survival showed no significant difference among different subtypes (P=0.308). As for type Ⅱ and type Ⅲ tumors underwent R0 resection, resection via laparotomy showed survival advantage over resection via thoracotomy (49.1% vs 23.3%, P=0.045), and the 5-year survival was similar between proximal subtotal gastrectomy and total gastrectomy (40.1% vs 42.5%, P=0.278). Conclusion    Type Ⅱ and type Ⅲ tumors have different clinicopathological characteristics. But the 5-year survivals have no significant difference between different subtypes. Maybe the follow-up is still short. As for type Ⅱ and type Ⅲ tumors, resection via laparotomy is recommended, and suitable surgical procedure should be chosen according to tumor invasion.

Key words: adenocarcinoma of the esophagogastric junction, Siewert classification, clinicalpathological characteristics, surgical procedures, prognosis